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POLICY DIALOGUES

CHRODIS PLUS Guide

National Level 11 / June / 2018

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Table of Contents

What is a Policy Dialogue? ........................................................................................................... 3

Objectives of the CHRODIS Plus Policy Dialogues ......................................................................... 5

Policy Dialogue Stages ................................................................................................................. 7

Policy Dialogue Overview of Roles ................................................................................................ 8

Policy Dialogue Workflow ......................................................................................................... 10

Policy Dialogue Report Form ....................................................................................................... 12

Policy Dialogue Action Plan ........................................................................................................13

Annex 1: Policy Dialogue Schedule ........................................................................................... 14

Annex 2: Overview of Policy Dialogue Topics ........................................................................... 15

Annex 3: Policy Dialogue Evaluation Questionnaire ................................................................. 19

Task leaders: EuroHealthNet

- Claudia Marinetti (c.marinetti@eurohealthnet.eu)

- Andrew Barnfield (a.barnfield@eurohealthnet.eu)

Task co-leader and WP Leader: ISCIII

- Iñaki Imaz Iglesia (imaz@isciii.es)

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What is a Policy Dialogue?

Policy dialogues are more than just a discussion on a specific policy or on project’s outcomes. It is more than

inviting policymakers into one room and informing them of policy recommendations. A well-designed policy

dialogue can be the start of a policy process or embedded into it. At the same time, a single policy dialogue

will not trigger policy change instantly.

A policy dialogue can be defined as “an essential component of the policy and decision-making process, where

it is intended to contribute to informing, developing or implementing a policy change following a round of

evidence-based discussions, workshops, and consultations on a particular subject. It (…) can be conducted at

any level of the health system where a problem is perceived and a decision, policy, plan or action needs to be

made.”1 Policy dialogues can be useful tools at different points of the policy making process if “they occur early

in the process, the objectives may focus primarily on clarifying and framing the problem and identifying viable

solutions (…), if they occur later in the process they may focus primarily on the advantages and disadvantages

of the options and implementation strategies being considered.”2

They gather policymakers from health and other domains (e.g. finance, environment, infrastructure, etc.) as

well as relevant stakeholders to discuss a topic of mutual interest. The participants should bring different, and

at times opposing, positions to the dialogues. The facilitated discussions increase not only a mutual

understanding but also the quality of the outcomes. There is not a standard approach to the ‘perfect’ policy

as they greatly depend on e.g. the context, country or participants. Practically speaking, policy dialogues work

best when they are well-structured (which begins during the planning phase), limited participation (only upon

invitation) and in a small group. If they are carried out well, policy dialogues present constructive and

important sources not only of information but also solutions for policymaker’s decision-making.

To conduct a successful dialogue, certain prerequisites need to be in place. These will have been addressed

through a questionnaire completed by each member state. There are five essential points that must be

observed:

1. It is essential to have clearly defined objectives. This goes hand in hand with a clear vision of what

outcomes and results would be expected.

2. Policy dialogue’s discussions and participants need to be based on effective stakeholder and context

analyses, part of which is evidence-based background information.

3. Effective moderation and facilitation are key to have meaningful and comprehensive discussions.

1 http://www.who.int/alliance-hpsr/news/2015/dialoguebrief/en/ 2 http://epoc.cochrane.org/sites/epoc.cochrane.org/files/public/uploads/SURE-Guides-v2.1/Collectedfiles/source/07_policy_dialogues/policy_dialogue_objectives.html

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4. Policy dialogues should define a list of possible and tangible actions or steps, some of which may be

implemented during the Joint Action.

5. Policy dialogues are not confined only to the meeting: it is crucial for follow-up and the will to

implement and should not be underestimated in terms of importance.

In short, policy dialogues are not dissemination events. While they may make use of CHRODIS Plus outputs to

some extent, the main goal should not be to disseminate information about the results but rather to engage

a small group of ‘influencers’ and senior change-agents in a practical and solution-oriented policy discussion.

This means we foresee a meeting, where all invitees are fully participating. Thus, number of assistants of

participants, organisers and potential other CHRODIS Plus observer partners for observation should be

reduced to the minimum.

Outcomes

Depending on the objectives, the progress of the policy making process and other variables, the (intended)

outcomes may differ. Moreover, it is important to state clearly the envisaged results. Possible outcomes would

be:

Reaching a trigger for decisions on a topic that has been considered already

Reaching a consensus on steps to take at different levels

Identifying financing options

Defining tools/mechanisms to track and measure results

Finding triggers for behavioural change of stakeholders

Learning enablers for enhanced ownership (of problems, solutions, actions) of stakeholders

Facilitating aid factors for implementing identified actions

Increasing trust between participants (if policy dialogue is truly participatory and inclusive) by

improved mutual understanding

Improving transparency and accountability for implementing actions

Involving high level decision makers

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Objectives of the CHRODIS PLUS Policy Dialogues

The general purpose of work package 4 is to “support Member States on the implementation of new or

innovative policies and practices for empowerment, health promotion and prevention, management of chronic

diseases and multimorbidity” and the policy dialogues specifically aim to strengthen “the development and

adoption of national, regional and local policies related to health promotion, prevention and innovative

management of chronic diseases”. The purpose is not to ‘just organise good policy dialogues’ but to use it as

a vehicle to advance the debate in the countries and achieve better action, in the most appropriate way for

the different countries. The aspiration is to reach meaningful outcomes that will help this purpose.

Both national and EU-level policy dialogues are designed to either (a) start policy processes or (b) be embedded

in and support already on-going policy processes. Naturally, one policy dialogue will not change legislation or

bring about a new strategy. Nevertheless, it can contribute to previously established objectives. This will

happen if there is a good execution, right people are engaged and discussions are well structured. The

expectation is to get a process rolling that can lead to effective and substantial change. The objectives can vary

across countries and topics:

Contributing to legal opportunities

Establishing institutional/cross-sectoral collaboration

Involving stakeholders from other sectors in a current issue

Kick-starting a policy process in your country

Embedding policy dialogue, if a policy process is already ongoing

Identifying tangible actions that will address the identified problem

Involving senior management in new plans

Approach

The topics of the two EU-level dialogues are already set (1) Employment & Chronic Diseases; (2) Innovative

Financing of Health Systems and need to only be narrowed down. EuroHealthNet, for example, will focus the

latter on “Innovative Financing of Health Promotion to Help Secure the Sustainability of Health Systems”.

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Nine national partners have committed to policy dialogues in health promotion (Croatia, Hungary, Iceland,

Italy, Lithuania, Malta, Netherlands, Poland, and Spain). Six partner countries (Belgium, Greece, Ireland,

Portugal, Slovakia, and Slovenia) have not yet set an overall topic and will have to. All countries are asked to

narrow the scope and specify the problem and issue within the topic chosen through a pre-established

questionnaire.

Final Deliverable In month 30 (February 2020), the task leader EuroHealthNet will deliver the final deliverable of this task. It will

include 17 action plans derived from the policy dialogues, a description of the (potential) uptake of the

identified actions and include hands-on guidance on conducting successful dialogues.

The action plans identify the “possible tangible actions for country-specific impact for better prevention and

management of chronic diseases”. During each policy dialogue, time should be dedicated to discussing and

identifying practical (policy) solutions for the country. If possible and time allows, the task leader and Joint

Action coordinators would encourage the implementation of some of these actions in the follow-up of the

policy dialogues.

Budget Each country has a budget of €1,200 to cover the costs of e.g. catering, (national) travel costs of participants or an external facilitator. EuroHealthNet has €2,800 available in total to support partners, who go beyond their budget (within reason). The decision will have to be made on an individual case basis. Furthermore, EuroHealthNet can spend up to €5,000 in total for the translation of materials of the policy dialogues (e.g. background documents). Partners are encouraged to request translation services (either into English or their national language), which will be centrally coordinated by EuroHealthNet.

EuroHealthNet’s Role EuroHealthNet is the task leader for the policy dialogues and provides the general framework for organising

and holding policy dialogues as well as compiling the final deliverable. It is up to the partners to set the agenda

and objectives and organise the logistics of their policy dialogue. Nonetheless, EuroHealthNet can guide

partners through the process, give advice on the agenda and invitees and is available to provide support

tailored to each country’s need. EuroHealthNet will travel to every policy dialogue with 1 to 2 people and,

depending on the arrangements with the partner, can potentially moderate.

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Policy Dialogue Stages The organization of the policy dialogue will follow the workflow pattern set out on page 13 below. The stages of the policy dialogue will develop out of the questionnaire that national organizers completed in the opening stages of the process. The objectives for the dialogue and the topic have been reviewed and refined in close collaboration with the task leaders. The topic will be specific to the member state but it is anticipated that some themes may overlap with others. This tentatively points towards the added value of the EU helping member states to address their concerns and work towards a coordinated response. The policy dialogue must be carefully planned. The invited participants will be drawn from key sectors. They will include influential policymakers and stakeholders to ensure the policy dialogue has the potential to make real changes to the lives of European citizens. An appropriate venue must be selected to maximize attendance confirmation and the policy dialogue should be conducted in the national language to encourage free and frank discussions. It is essential that the dialogue is limited to eight to twelve participants and held in a closed session without an invited audience. The invitation process must be conducted with care. Due consideration has to be given to attracting high ranking officials and their other engagements. To help with the process and to emphasize the importance of the policy dialogue, official invitation letters must be signed by the Chrodis Plus Coordinator. Following acceptance, policy dialogue documents must be sent to the participants at least two weeks prior the dialogue and include the pre-prepared question list. It is essential that these documents are also sent to the task leaders. Included in these documents should be a draft agenda. This must be in more detail than was included in the policy dialogue questionnaire. The task leaders are available to liaise with the national organizer throughout the process.

It is the responsibility of the national organizer to arrange for external or professional moderation. The moderator should be a person with good experience and knowledge of the topic under discussion. The national organizer must arrange for an appropriate colleague to compile the minutes and complete the reporting documents. The roles of the organizer, moderator, and rapporteur is outlined in the following chapter. The final stage of the policy dialogue with involve completing the pre-prepared reporting documents that detail the outcomes of the discussion, record the tangible actions that will address the identified problem, and demonstrate the added value of the EU. These documents must be sent to the task leaders within 3 weeks of the policy dialogue. The work package leader will then officially conclude the policy dialogue.

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Policy Dialogue Overview of Roles Organizer The role of the organizer is essential to a successful policy dialogue and the production of tangible actions for the identified problem. The first aspect to the organizer’s role is to manage the expectations of the participants. It is important to ensure that all participants’ expectations are realistic and correspond with the stated aims of the policy dialogue. There are several key tools that should be used to hold an efficacious discussion. First, the invitation to participants should clearly state the aims of the policy dialogue and must include a briefing note that includes all essential documents for the topic under discussion. Second, the policy dialogue introduction and briefing should be given by the organizer before handing over to the moderator. This is an opportunity to clarify the rules of the dialogue and re-iterate the stated aims of the discussion. Third, a set of pre-prepared questions on the topic should be developed to guide the discussion towards agreement on tangible actions. Fourth, the dialogue report and action plans are the key outputs of the policy dialogue and their completion should be conducted in correspondence with the rapporteur. The set of pre-prepared questions should include questions which unpack the barriers and facilitators of the identified problem, how the problem can be actively resolved, and enable participants to comment on the competing priorities and pressures from their perspectives. A pre-prepared set of questions is also useful to ensure that the participants are given adequate opportunity to discuss all the relevant issues, to aid the moderator in guiding the discussion, and to ensure the policy dialogue keeps to time while at the same time producing tangible actions. A set of pre-prepared questions will also help the moderator adopt a flexible approach and should include different types of questions: introductory questions to get participants discussing the issues in general before narrowing in on particular issues; inking questions to enable the moderator to move from broad themes to the more specific topics; key questions to address the key issues which the moderator needs to explore in the policy dialogue. After exploring the issues, it is important to remember to elicit tangible and workable actions from participants. The organizer should be present throughout the policy dialogue and liaise with the task leaders throughout the process of the policy dialogue and follow-up activities. Moderator The role of the moderator is essential to a successful policy dialogue on the day. The moderator’s role is to maintain the flow of the discussion while directing the participants to agree on tangible actions. Ideally, this means that the moderator should be an external person to the organizing institution. However, it is imperative that they have a thorough knowledge of the topic as this will

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help to direct the discussion and help to investigate areas for more in-depth evaluation of the barriers and facilitators of the identified problem. The role of an experienced external moderator will help the moderation remain neutral yet actively involved. This will help to maintain objectivity in directing a discussion on a sensitive topic. Key here is to maintain the 80:20 rule (the participants should talk for 80% of the time and the moderator for 20%) and to adopt the 7-second pause and inquire approach (ask clear questions then pause for responses and then ask for calcification for more information). It is fundamental to avoid asking why and allowing the participants to pass the blame on to people who are not participating in the dialogue. In addition, the moderator should be an active listener paying close attention to the direction of the discussion and incorporate the participant’s comments to summarize salient points. They also need to be flexible with the pre-prepared questions and adapt to the discussion to remain open to fruitful avenues for establishing tangible actions that will address the identified problem. On the day of the policy dialogue the moderator will lead the discussion after the organizer has given the official welcome. The policy dialogue organizer will welcome the participants and present the introductory briefing document before handing over to the moderator. The moderator should introduce themselves and the rapporteur and briefly explain their roles. They should also ask the participants to either introduce themselves or ask them to complete the introduction task they have been given as part of their invitation. The moderator should then briefly outline the aim of the dialogue and re-iterate the key points covered in the briefing note. Finally, the moderator should explain the house rules and that their individual responses will be anonymized in the reporting documents. Rapporteur The role of the rapporteur is to accurately record and report the discussion of the policy dialogue. The rapporteur is tasked with clearly identifying the tangible actions that will address the identified problem. The rapporteur needs to be a highly skilled minute-taker and have experience of using discretion to create a record of the event that could be followed by someone who is not in attendance at the meeting. The use of Chatham House Rules is to help establish an environment that allows a full and frank discussion of the identified problem. When a meeting, or part thereof, is held under the Chatham House Rule, participants are free to use the information received, but neither the identity nor the affiliation of the speaker(s), nor that of any other participant, may be revealed. For recording purposes this means that the rapporteur has to be attentive to the flow of the discussion and accurate in their recording of the outcomes. It is essential that the rapporteur is an excellent listener with the proven ability to capture the essence of what people say and capture it in writing. They must also

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have excellent writing and editing skills to be able to produce effective reporting documents. This is a serious role within the policy dialogue and must be carefully awarded.

Policy Dialogue Workflow

1. Completed Policy Dialogue questionnaire received by Task Leader.

2. March 2018 (or ASAP from date questionnaire received): Initial overall feedback including resources to be considered, request for clarification, request for additional documents (e.g. explanatory paragraphs on EU added value or on alignment with Chrodis Plus work), in co-operation with the task co-leader.

3. Response from organizers within three weeks.

4. Sharing of dialogue plan with task co-leader and ad hoc consultation with Chrodis Plus WP4 coordination team partners where deemed appropriate by task leader and co-leader.

5. Further feedback to organizers, including check list and invitation letter template, reporting back/identification of tangible actions template.

6. Information on policy dialogue programme sent to Chrodis Plus WP4 Coordination Team Partners.

7. Policy Dialogue face to face meeting between national organizers and task leader and co-leader.

8. The National organizer must send policy dialogues reporting documents to task Leader, who will share them with the task co-leader.

9. Discussion of policy dialogue and reporting documents if necessary with task leader and Chrodis Plus coordinator.

10. Final version of the reporting documents are completed and sent to the task leader who will confirm acceptance. The work package leader will then formally conclude the policy dialogue process.

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Policy Dialogue Evaluation

Work Package 3 leader AQuAS will be involved in evaluating the process and outcomes of the policy dialogues. Clearly defined objective and expectations of outcomes are crucial for this (please see Annex 3 for the evaluation questionnaire).

Policy Dialogue Reporting Documents

The following documents are to be used to record the policy dialogue and the resulting actions that can be measured. The first document is to be used to record the unattributed narrative minutes. The second is to be used to record the next step that are resultant of the policy dialogue.

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Policy Dialogue Report Form

Policy Dialogue Title: _____________________________________________ Narrative Minutes (unattributed)

List of documents

Agenda/pre-circulated question list

Points of discussion

Conclusion

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Policy Dialogue Action Plan

Goal:

Action Who When What Resources Identified Barriers Success/Outcome

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Annex 1: Policy Dialogue Schedule

Draft Schedule

Policy dialogues should last for three to four hours; for example:

10 mins Welcome – Policy Dialogue rules, reporting, and introduction of moderator and rapporteur.

30 mins Opening Statements of each participant, reflecting the various views and perspectives concerning the defined problem and policy action.

90-120 mins Policy Dialogue (guided discussion) this will include consensus building for tangible actions.

15 mins Optional slot on EU level declaration concerning chronic diseases (Consensus Statement)

15 mins Moderator summarizes policy dialogue and outlines conclusion

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Annex 2: Overview of Policy Dialogue Topics

Belgium: As soon as possible (no specific date) Brussels, The federal public service of health, food chain safety and environment Inter-ministerial Conference on Public Health - Working group chronic diseases / integrated care Developing and implementing integrated care in Belgium requires close cooperation between federal and regional authorities and many departments e.g. Employment, Finance, Education, Justice, Housing The policy dialogue will address the fourth action line “additional measures and complementary actions of the various ministers within their own competences” Croatia: Autumn 2018 Zagreb, Ministry of Health Implementation of The Action Plan for the Surveillance and Prevention of Chronic/non-Communicable diseases 2017-2025 Implementation of The Action Plan for the Surveillance and Prevention of Chronic diseases through a comprehensive, multi-sectoral nationwide approach. The policy dialogue will discuss the response to the UN Sustainable Development Goal to improve health and well-being that focuses on the reduction of premature mortality from NCDs for 30% by 2030. Greece: 23 February 2018 Thessaloniki, Greece, Grand Palace Hotel Implementation of Integrated Care services for the Elderly and Chronic Patients Integrated care services for elderly with multiple chronic diseases The policy dialogue will discuss implementing relevant policies and practices to address integrated care for the elderly. The Primary Care of our Health and Social Care System, currently under reform, presents a good opportunity for the adoption of this kind of service. Hungary: June 2019 Budapest, Semmelweis University, Basic Medical Science Center Preventing access of adolescents to tobacco products in Hungary The policy dialogue will discuss increasing the protection of adolescents with regard to access to tobacco products. The dialogue will examine the process of establishing an improved controlled sale of cigarettes in authorized shops, i.e. the control of access. In addition, what legal and regulatory

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measures should be implemented to decrease direct and indirect sales of tobacco products to adolescents? Ireland: April or May 2018 Dublin, the Institute of Public Health in Ireland Tobacco control and inequalities – reflecting on the first five years of Tobacco Free Ireland Implementation of tobacco control policy to focus on health inequalities The policy dialogue will capture learning on how inequality dimensions can be built into policy and practice. It will explore and document some of the opportunities and challenges in tackling inequalities within national tobacco control policies and programmes. Lithuania: January 2019 to September 2019 Vilnius, Institute of Hygiene An action plan to reduce the harmful use of alcohol in Lithuania Developing a focus on reducing of alcohol use and alcohol-related harm The policy dialogue will use EU policy instruments to develop measures for an action plan of Lithuania that will be designed in line with existing evidence and good practices. Malta: March 2019 or April 2019 Valletta, Ministry for Health Promoting water consumption through environmental change: the way forward How to make free potable drinking water prominently and widely accessible in public facilities, including parks, playgrounds, schools, public buildings, worksites and clinics. The policy dialogue will promote discussion of how access to and availability of safe drinking water can be promoted at the neighbourhood or locality level. Netherlands: June to September 2018 or February 2019 Amsterdam, Community Centre (to be selected) Health for all. Exploring innovative policy alliances for a healthier Netherlands Identifying options to improve inter-sectoral collaboration at national level in order to tackle persistent health inequalities in The Netherlands, especially as regards NCDs The policy dialogue will discuss what measures need to be taken to increase the healthy life expectancy among the Dutch population with low socioeconomic status by one year.

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Portugal: End of 2018 or February 2019 Lisbon, Directorate-General of Health Tackling NCD prevention: The role of Nutrition and Physical Activity The policy dialogue will assess the measures that are available to improve nutrition and physical activity participation children and young people. In Portugal reveals that 25% of children under 10 years old have problems of overweight, being from those 7.7% already obese. In children from 10 to 17 years, this percentage increases to 32.3%, being 8.7% obese. The policy dialogue will discuss the promotion of a collaborative approach to child nutrition and physical activity at a national level. Slovakia: September 2018 Bratislava, Congress hall of the Ministry of Health of the Slovak Republic Collaborative approach in Control and Prevention of cardiovascular and metabolic disorders To support health promotion across the broader health system, increase the use of clinical preventive services, provide services that extend care outside the clinical setting, and implement interventions that reach whole populations The policy dialogue will discuss the promotion of collaborative approach to end childhood obesity with a particular focus on the life course approach and screening programmes. Slovenia: October 2018 or February 2019 Ljubljana, National Institute for Public Health Integrated care in Slovenia The implementation of Integrated Care services in every day clinical practice The policy dialogue aims to bring together the core stakeholders to agree on:

1. The working vision of what integrated care is 2. Identifying potential priorities, opportunities and barriers to achieve integration of care 3. Identifying the potential positions of power, and potential sustainable drivers for the process 4. Identifying smart steps forward to support policy process (such as windows of opportunities

in short term, and sustainable processes in the middle/long run), its implementation and sustainability.

Spain: November 2018 or February 2019 Madrid, Ministry of Health Improving health trough non-health alliances The dialogue will address cross-sectorality within the framework of the Health Promotion and Prevention Strategy in the National Health System (HPPS).

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The goal of the policy dialogue is to raise awareness about health in all policies, to identify the relevant stakeholders and to draw up the coordination mechanisms and milestones for the creation of the committee and the follow up of the HPPS. EU Level 1: March 2019 Brussels, European Parliament Employment and Chronic Diseases The policy dialogue will address two main aspects:

1. The social and economic occupational implications on employment reintegration of these patients sector of inclusion, integration and reintegration of people suffering of CDs

2. The difficulties of implementation of prevention measures in the workplace, trying to help employers, institutes, political organizations to understand the benefits of prevention of CD and to implement prevention activities within identified high-risk populations by adapting the workplace.

EU Level 2: March 2019 Brussels, European Parliament Innovative Financing of Health Promotion to Help Secure the Sustainability of Health Systems The policy dialogue will address two main aspects:

1. How to steer Member states to take specific actions within their powers to advance investment shifts?

2. How to convince investment decision makers to take new approaches, which may only have outcomes in the long term?

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Annex 3: Policy Dialogue Evaluation Questionnaire

CHRODIS Plus Policy Dialogues Survey

Thank you for taking the time to provide your valuable feedback relating to the Policy Dialogue you recently attended in the context of CHRODIS Plus Joint Action (2017-2020), implementing good practices for chronic diseases.

To evaluate the effectiveness and relevance of the Policy Dialogues and consultations with experts, we kindly ask for your assistance in completing this feedback survey. Your insights and comments will help shape and strengthen future Policy Dialogues.

The survey should take less than 5 minutes to complete. Your responses to this survey will be kept confidential.

Please provide us with the following information about yourself:

1. You are: [Drop down menu of occupations]

2. In which country did you participate? [Drop down menu of countries]

3. How would you rate each of the following?

From 1-Poor to 5-Excellent

Background information shared in preparation for the Policy Dialogue

Sufficiency of evidence provided and discussed in the Policy Dialogue

Relevance of the topics covered

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Achievement of goals as delineated in the agenda

Moderation

Definition and agreement of outcomes and action plan to move forward

The location of the Policy Dialogue

Technical conditions (material, etc) for the Policy Dialogue

4. What is, in your opinion, the most relevant topic or idea covered/shared during this Policy Dialogue for you and your country and why?

5. What do you see are the primary enhancing factors and/or barriers for the implementation and sustainability in your National Policies of the outcomes/proposals agreed in this Policy Dialogue?

Enhancing factors:

Barriers:

6: In your opinion, what do you think worked well and what could be improved from this meeting?

7. Overall, how would you rate this Policy Dialogue?

From 1-Very Poor, to 10-Excellent

8. Do you have any further comments or suggestions?

Thank you for taking the time to complete this survey. We truly value the information you have provided. Your responses will contribute to our analysis and help us to improve policy dialogues in the future.

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